title: Monoplex LightCycler polymerase chain reaction quantitation of the HER2 gene for quality assurance of HER2/neu testing by immunohistochemistry and fluorescence in situ hybridization.
abstract: BACKGROUND
  Assessment of HER2 by immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH) is a standard practice for breast carcinomas. Testing is associated with a 20% disagreement between laboratories. The College of American Pathologists (CAP) guidelines for HER2 testing include validation of HER2 test methods by achieving 95% concordance with another validated method. Our laboratory requires IHC 3+ FISH nonamplified specimens to undergo retesting by polymerase chain reaction (PCR). A random sample of IHC 2+ cases are routinely tested by PCR. We found this practice useful for resolving discrepancies in HER2 testing.
  
  
  METHODS
  At clinician request, seventy-nine 3+ and one hundred forty-eight 2+ cases were tested by FISH. In 22 cases, IHC was 3+ but FISH was nonamplified. These 22 cases underwent HER2 LightCycler monoplex polymerase chain reaction (MPCR) testing. Seventeen 2+ nonamplified cases were tested by MPCR.
  
  
  RESULTS
  Twenty-one 3+, FISH nonamplified cases were found to be MPCR nonamplified. One IHC 3+, FISH nonamplified case was MPCR amplified. Seventeen 2+, FISH nonamplified cases were MPCR nonamplified. In all but one case, FISH and MPCR were concordant.
  
  
  CONCLUSIONS
  American Society of Clinical Oncology/CAP guidelines propose validation of testing procedures by showing 95% concordance with a validated test for positive and negative assays. Specific actions are not recommended to resolve discordances between tests. Our laboratory uses 3 different modalities for HER2 testing. We have found that our 2 methods for testing gene amplification status show a higher degree of concordance between themselves than either did with IHC. Review of the 3+ IHC nonamplified cases showed them to have a dark, granular circumferential staining pattern.
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA. layfiel@aruplab.com
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Layfield
authors.forename: Carlynn
authors.initials: C
authors.lastname: Willmore-Payne
authors.forename: Gary
authors.initials: G
authors.lastname: Isom
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Holden
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D002277:Carcinoma / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D003951:Diagnostic Errors / Q000517:prevention & control / Q000592:standards; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods* / Q000592:standards; D017404:In Situ Hybridization, Fluorescence / Q000379:methods* / Q000592:standards; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results